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No Updates
Measure Name | # of distinct mandatory eligibility group values populated for duals (ELIGIBILITY-GROUP = 23, 24, 25, 26) |
---|---|
File Type | ELG |
Measure ID | EL-3-024-29 |
Measure Type | Count |
Content area | ELG |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | N/A |
Category | Beneficiary eligibility |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 3 |
---|---|
Maximum | 4 |
TA Minimun | 3 |
TA Maximum | 4 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | ELIGIBILITY-GROUP |
---|---|
DD Data Element Number | ELG087 |
Annotation | Count the number of mandatory eligibility groups for dual eligibles with at least one MSIS ID with a primarily eligibility group indicator associated with it |
---|---|
Specification |
STEP 1: Enrolled on the last day of DQ report month Define the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria: 1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing 3. MSIS-IDENTIFICATION-NUM is not missing STEP 2: Eligibility determinants on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria: 1. PRIMARY-ELIGIBILITY-GROUP-IND = 1 2a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missing OR 2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing 3b. ELIGIBILITY-DETERMINANT-END-DATE is missing STEP 3: Frequency of mandatory eligibility groups Of the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 23, 24, 25, 26 STEP 4: Count of categories Of the 4 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID |